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New EPSDT Psychology, Mental & Behavioral Health Code Conversion Billing Guide

April 23, 2019

Effective for dates of service on or after August 1, 2019, the HCPCS Local Level III codes listed below for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health services are no longer reimbursable. These codes are converting to national HIPAA compliant CPT codes, which are required on EPSDT psychology, mental and behavioral health services claims. Providers submitting UB 04 claim forms or ANSI 837I transactions must bill revenue codes in addition to the national procedure codes.

New Treatment Authorization Requests (TARs)/Electronic TARs (eTARs) for EPSDT psychology, mental and behavioral health services must include CPT national codes effective for dates of service on or after August 1, 2019. TARs and eTARs using the converting HCPCS Level III local codes will only be valid for dates of service on or before July 31, 2019.

TARs/eTARs with service “from” and “through” dates on or before July 31, 2019, should be submitted using HCPCS Level III local codes. TARs/eTARs authorized with “through” dates beyond July 31, 2019, must be end-dated, and a new TAR/eTAR should be submitted with the appropriate CPT national codes to cover any remaining service period on or after August 1, 2019.

New Service Authorization Requests (SARs)/Electronic SARS (eSARs) for EPSDT psychology, mental and behavioral health services must include CPT national codes effective for dates of services on or after August 1, 2019. SARs/eSARs using the HCPCS Level III local codes will only be valid for dates of service on or before July 31, 2019.

SARs/eSARs with service “from” and “through” dates on or before July 31, 2019, should be submitted using HCPCS Level III local codes. SARs/eSARs authorized with “through” dates beyond July 31, 2019, must be end-dated, and a new SARs/eSARs should be submitted with the appropriate CPT national codes to cover any remaining service period on or after August 1, 2019.

If the submitted TAR/SAR is for the purpose of updating the codes for the same authorization period, it will not be reviewed for medical necessity.

Updated manual pages will be released in a future Medi-Cal Update.

The EPSDT psychology, mental and behavioral health services code conversion, effective August 1, 2019, is as follows:

Local Code – Description National Revenue Code – Description National Procedure Code – Description Modifier – Description
Z5814 – EPSDT: marriage/family/child counsel

Z5816 – EPSDT: social worker
0914 – Behavioral health treatment/services, individual therapy 90837 – Psychotherapy, 60 minutes with patient EP – Service provided as part of Medicaid early and periodic screening diagnostic and treatment (EPSDT)
Z5820 – EPSDT: case management 0900 – Behavioral health treatment/services, general 99366 – Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional

Or

99368 – Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional
EP – Service provided as part of Medicaid EPSDT

Local Code – Description Action
Z5800 – EPSDT Supplemental Services: Research Psych Code is terminated
Z5810 – EPSDT Supplemental Services: Nurse Practitioner Code is terminated
Z5850 – EPSDT Services: Individual alcohol and other drug counseling ½ hour Code is terminated